Most Relevant Information
Provider Data
| NPI Number: | 1003526989 |
| Provider Name: | DANIEL JOHN CALLICOAT SOIDC |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1002X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/01/2022 |
| Last Updated: | 12/01/2022 |
Provider Practice Location
BLDG RR 361
CAMP LEJEUNE
NC
28540
Practice Location Phone/Fax
| Phone: | 9104402504 |
| Fax: |
Provider Mailing Location
BLDG RR 361
CAMP LEJEUEN
NC
28540
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |